Characteristics and Factors Influencing Clinical Pharmacy Services in Small Hospitals in British Columbia: A Theory-Informed Survey
Bibliographic record
Abstract
Background: Most hospitals in British Columbia have fewer than 200 beds, yet the clinical pharmacy services provided and factors influencing their delivery in this context are unknown. Objectives: To describe on-site clinical pharmacy services and associated contextual barriers and enablers in small BC hospitals. Methods: Between January and April 2022, an internet-based survey questionnaire was deployed to all pharmacy licence holders at BC hospitals with fewer than 200 beds (n = 23 licence holders representing 58 hospitals). Site characteristics, clinical activities, and barriers to and enablers of clinical pharmacy services (according to the Consolidated Framework for Implementation Research [CFIR]), as well as free-text responses, were captured. Results: Of the 23 licence holders invited to participate, 18 (78%) responded, representing 37 (64%) of the small hospitals. Provision of clinical pharmacy services was reported at 27 (73%) of the 37 hospitals. Resolution of drug therapy problems and patient education were delivered at all of these hospitals. Conversely, the comprehensive patient care bundle and discharge medication reconciliation were never performed at 15 (56%) and 11 (41%), respectively, of these 27 hospitals. Of the 9 CFIR barriers, insufficient external networking and insufficient resources were reported by 17 (94%) and 16 (89%), respectively, of the 18 respondents. Funding and staffing barriers were reported, using free text, by 14 (78%) and 13 (72%), respectively, of the 18 respondents. Of the 21 CFIR enablers, the following 5 were reported by all respondents: agreement that clinical services are supported by adequate evidence, that such services will improve quality, that they will meet patient needs, that they will satisfy patients, and that a strong need exists for these services. Conclusions: On-site clinical pharmacy services were delivered at most small BC hospitals; however, opportunities exist to expand clinical services. Pharmacy leaders should implement change strategies that overcome contextual barriers and enhance enablers. Keywords: small hospital, clinical pharmacy, clinical pharmacy key performance indicators, barriers and enablers, implementation science RÉSUMÉ Contexte : La plupart des hôpitaux de la Colombie-Britannique comptent moins de 200 lits, mais on ne sait pas quels sont les services de pharmacie clinique qui y sont offerts ni les facteurs influençant leur prestation dans ce contexte. Objectifs : Décrire les services de pharmacie clinique sur place ainsi que les obstacles et les éléments facilitateurs contextuels associés dans les petits hôpitaux de la Colombie-Britannique. Méthodologie : Entre janvier et avril 2022, un questionnaire en ligne a été envoyé à tous les titulaires d’une permis d’exercice en pharmacie dans les hôpitaux de la Colombie-Britannique comptant moins de 200 lits (n = 23 titulaires représentant 58 hôpitaux). Les caractéristiques des sites, les activités cliniques ainsi que les obstacles aux services de pharmacie clinique et les éléments facilitant ceux-ci (selon le Consolidated Framework for Implementation Research [CFIR], ou Cadre consolidé pour la recherche sur la mise en œuvre, en français), ainsi que des réponses libres, ont été recueillies. Résultats : Sur les 23 titulaires de permis invités à participer, 18 (78 %) ont répondu, soit 37 des petits hôpitaux (64 %). Des services de pharmacie clinique ont été rapportés dans 27 des 37 hôpitaux (73 %). Tous les hôpitaux assuraient une résolution des problèmes liés à la pharmacothérapie et l’éducation des patients. En revanche, la gamme de soins complets aux patients et le bilan comparatif des médicaments au moment du congé n’ont jamais été offerts dans 15 (56 %) et 11 (41 %), respectivement, des 27 hôpitaux ayant déclaré offrir des services de pharmacie clinique. Parmi les 9 obstacles du CFIR, l’insuffisance du réseau externe et des ressources a été signalée par respectivement 17 (94 %) et 16 (89 %) des 18 répondants. Les obstacles liés au financement et au personnel ont été rapportés au moyen des réponses libres par 14 (78 %) et 13 (72 %) des 18 répondants. Parmi les 21 éléments facilitateurs du CFIR, les 5 suivants ont été rapportés par tous les répondants, qui s’accordent sur le fait que ces services cliniques : sont soutenus par des éléments probants adéquats; amélioreront la qualité; répondront aux besoins des patients; donneront satisfaction aux patients; répondent à un besoin important. Conclusions : Des services de pharmacie clinique étaient offerts dans la plupart des petits hôpitaux de la Colombie-Britannique; toutefois, il y a des occasions de les élargir. Les leaders en pharmacie devraient mettre en place des stratégies de changement qui surmontent les obstacles contextuels et renforcent les éléments facilitateurs. Mots-clés : petits hôpitaux, pharmacie clinique, indicateurs clés de performance en pharmacie clinique, obstacles et éléments facilitateurs, science de la mise en œuvre
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.008 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.003 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".